Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients

Objective:To investigate peritoneal defense during icodextrin use in contin uous cyclic peritoneal dialysis (CCPD). Design: In an open, prospective, P-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long dayt ime dwell. Setting: University hospital and teaching hospital. Patients: Both established and patients new to CCPD were included. A life e xpectancy of more than 2 years, a stable clinical condition, and written in formed consent were necessary before entry. Patients aged under 18 years, t hose who had peritonitis in the previous month, and women of childbearing p otential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients (19 Glu, 19 Ice) started the study. The median follow -up was 16 and 17 months for Glu and Ico respectively (range 0.5 - 25 month s and 5 - 25 months, respectively). Outcome Measures: Peritoneal defense characteristics and peritoneal dialysi s-related infections were recorded every 3 months. Results:Total peritoneal white cell count tended to decrease over time in b oth groups. After 1 year, absolute numbers and percentages of effluent peri toneal macrophages (PM Phi s) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years. Percen tage of mesothelial cells increased overtime in Ico patients. The phagocyti c capacity of PM Phi s decreased over time, resulting in a borderline signi ficant difference for coagulase-negative staphylococci (p = 0.05) and a sig nificant difference for Escherichia coli(p < 0.05) phagocytosis in favor of Ico patients. PM Phi oxidative metabolism remained stable over time withou t a difference between the groups. PM Phi, cytokine production and effluent opsonic capacity also remained stable over time. Finally, 16 peritonitis e pisodes in Glu and 14 in Ico patients occurred. Glucose patients had 37 and Ico patients 32 exit-site infections during the study. Conclusion: CCPD patients using Ico did equally as well as Glu-treated pati ents with respect to clinical infections and most peritoneal defense charac teristics. However, in a few peritoneal defense tests, Ice-treated patients did better.